tbuckley/cabot-search huggingface dataset:
Abstract 13601: An Evidence-Based Population Screening Strategy for <i>TTN</i> : Statistical Analysis of Over 450,000 Clinicogeomic Records Reveals High Prevalence of Cardiomyopathy in Carriers of Cardiac <i>TTN</i> tvs With Atrial Fibrillation
Authors: Kelly M Schiabor Barrett, Elizabeth T Cirulli, Alexandre Bolze, Chris Rowan, Gai Elhanan, Joseph J Grzymski, William Lee, Nicole L Washington
Journal: Circulation (2022)

Introduction: Truncating variants in TTN ( TTN tvs) are the largest genetic cause of dilated cardiomyopathies (DCM). In populations, genetic variation in TTN is pervasive and penetrance estimates for DCM are low, even when carriers are limited to those with TTN tvs in exons with “percentage spliced in” index &gt; 90 (hiPSI), a representation of constitutive cardiac expression. Patients with cardiomyopathies (CM) often carry a large number of other cardiac conditions, such as atrial fibrillation (Afib). We sought to confirm this association and determine whether the presence of Afib and a hiPSI TTN tv predicted CM. Results: Leveraging clinicogenomic data from ~450,000 individuals in two health systems, we show support for associations with both CM and Afib at the population level. We perform a sliding window analysis of TTN tvs and confirm the association is specific to hiPSI exons, with no meaningful associations in exons with less cardio expression. The combination of hiPSI TTN tv carrier status and early Afib diagnosis (dx before age 60) finds a subset of TTN carriers at high risk for CM (34% prevalence) - this risk is 3.5 fold higher than that of all hiPSI TTN tv carriers (9% prevalence) and 5-fold higher than non-carriers with early Afib (5% prevalence, p=4.8e-56 after controlling for age and sex). Further, Afib either predates or is concurrently diagnosed with CM in 72% of those with both diagnoses. Conclusion: CM and Afib are linked in hiPSI TTN tv carriers and may represent progressive manifestations of structurally-based heart failure. Our retrospective analysis suggests hiPSI TTN tv screening (~0.5% of cohorts) in conjunction with routine monitoring for arrhythmias may be an effective strategy to improve outcomes and reduce the incidence of severe cardio outcomes in the population.
Abstract 14184: Outcomes of Transcatheter Aortic Valve Implantation in Patients With Severe Morbid Obesity
Authors: Waqas Ullah, Adnan Halboni, Rashid Alhusain, Mohamed Zghouzi, Sohaib S Roomi, yasar sattar, M C Alraies
Journal: Circulation (2022)

Introduction: The long-term effects of severe obesity [body mass index (BMI) ≥50 kg/m 2 ) on the outcomes of Transcatheter Aortic Valve implantation (TAVI) remains unknown. Methods: The National Readmission Database (NRD) was used from 2015-2019 to identify all patients undergoing TAVI. Patients with severe obesity were compared with those having BMI &lt;50 kg/m 2 . The adjusted odds ratios (aOR) and 95% confidence interval (CI) were calculated using a propensity-score matched analysis (PSM).(Fig 1) Results: A total of 184,199 patients were included in the crude analysis. A selected sample of 4669 [2369 (50.7%) severely obese, and non-obese 2300 (49.3%)] were included in PSM analysis. At index admission, the adjusted odds of net adverse clinical events (NACE) (aOR 1.57, 95% CI 1.12 -2.20, p=0.01), all-cause in-hospital mortality (aOR 8.08, 95% CI 3.19-20.48, p=&lt;0.0001), and acute kidney injury were (aOR 1.48, 95% CI 1.25-1.74, p=&lt;0.0001) were significantly higher in severely obese patients compared with those having with BMI&lt;50 kg/m 2 . There was no difference in stroke (aOR 0.60, 95% CI 0.32-1.11, p=0.14), or major bleeding (aOR 1.63, 1.01-2.64, p=0.06) between the two groups. At 30- and 180-day, there was no significant difference in the incidence of stroke, or major bleeding between the two groups.(Fig 2) There was a steep increase in the utilization of TAVI in severely obese patients from 17.6% to 31.8% per total procedures during 2016 to 2019. Conclusions: Severely obese (BMI ≥50 kg/m 2) recipients of TAVI have a higher risk of NACE and mortality, however, there appearsto be no significant difference in the long-term risk of complications between severely obese and non-obese patients.
Abstract 13682: Not All Apical Left Ventricular Masses Are Thrombi: An Unusual Case of an Apical Left Ventricular Lipoma Presenting as Chest Pain and Palpitations
Authors: Ryan T Nguyen, ROSHNI A MANDANIA, Safi U Khan, Hassaan Arshad, Zohair Raza
Journal: Circulation (2022)

Introduction: Cardiac lipomas are rare primary cardiac tumors. Depending on the location, they can present with vague symptoms such as chest pain, palpitations, dizziness, or arrhythmias. Case Presentation: A 58 y.o. female with a PMH of HLD and HTN presents for evaluation of chest pain and palpitations. An initial CvCTA was negative for significant CAD. A TTE showed a 1.6cm x 1.42 cm echolucent mobile mass attached to the lateral wall of the LV (Figure 1.A). Initially, there was a reasonable concern for an LV thrombus. However, it was unusual since the TTE revealed a normal EF and overall wall motion. Due to suspicions of a non-thrombus LV mass, a cardiac MRI was performed which showed a highly mobile mass attached to the mid anterior/anterolateral wall and a chordae within the LV cavity (Figure 1.B, Figure 1.C). The lesion was T2-hyperintense with loss of signal during fat suppression, highly suspicious for a lipoma. Given the mass mobility and strong patient preference, an elective robotic surgical resection was performed with a surgical biopsy confirming a lipoma (Figure 1.D). Discussion: Cardiac lipomas are often silent; however, symptoms can range from benign palpitations to life-threatening arrhythmias and outlet obstruction. TTE is typically the first-line imaging choice, followed by either cardiac CT or MRI imaging used for further diagnostic evaluation. Treatment options include conservative observation or prophylactic resection for asymptomatic patients, and therapeutic resection for symptomatic patients. Conclusion: Cardiac lipomas should be considered in the differential for any cardiac mass. TTE is the first-line imaging choice followed by a cardiac CT or MRI. Treatment remains a discussion between the patient and physician, varying from conservative management of symptoms to definitive treatment with surgical resection.
Abstract 13877: Robotic Exercise Rehabilitation of Older Adults With Cardiovascular Disease Appears Safe and Effective
Authors: Akihiro Hirashiki, Atsuya Shimizu, Manabu Kokubo, Kenichiro Nomoto, Izumi Kondo, Hidenori Arai
Journal: Circulation (2022)

Introduction: Recent research has focused on the effects of physical exercise in improving the functional capacity of frail older adults. Training with a balance exercise assist robot (BEAR) system is effective for improving posture. We compared the clinical safety and efficacy of postural strategy training using a BEAR system with those of conventional resistance training or no training in older patients with cardiovascular disease (CVD). Methods: Elderly patients (n = 130; mean age, 77.5 years) admitted to our hospital for worsening CVD were randomly allocated to two cardiac rehabilitation (CR) groups: conventional resistance training (group R, n=65) and use of the BEAR (group B, n=65). After appropriate medical therapy, patients underwent cardiopulmonary exercise testing, including assessment of comfortable walking speed, timed up-and-go (TUG), and a short physical performance battery (SPPB), just before discharge and after a weekly for 4 months of CR. We followed up the patients for fall-related fractures and cardiac events, which were defined as hospitalization for worsening CVD or cardiac death, and then compared with non-CR group (group N, n=165). Patients were followed for a mean of 2.1 years. Results: BEAR use had no adverse effects in any patient. Comfortable walking speed, TUG, and SPPB had improved significantly in both groups at 4 months compared with baseline but did not differ significantly between groups. No fall related fractures occurred in group B and 2 in group R, there was no significant difference between the two exercise groups. On the other hand, although there was no significant difference in event-free survival rates between the two exercise groups, event-free survival was significantly greater in these groups than in group N ( P ˂ 0.001). Conclusions: Exercise training by using a BEAR system is safe and effective for older adults with CVD. We demonstrated here that BEAR use is comparable to conventional resistance training for improving exercise capacity and balance in elderly patients with CVD. Both exercise groups were better prognosis compared with non-exercise.
Abstract 12934: Refractory Hypercholesterolemia Induced by Treatment of Adrenocortical Carcinoma Demonstrates a Significant Challenge in Cardiovascular Disease Risk Management
Authors: Jameson G Wilbur, Amy James, Kathleen L Wyne
Journal: Circulation (2022)

Introduction: Hypercholesterolemia is a significant modifiable risk factor for cardiovascular disease (CVD). Prompt management of high-risk patients presenting with this condition is paramount, particularly for those with other comorbid conditions. Case Description: A 37-year-old female with long-standing well-controlled type 1 diabetes (over 30 years), metabolic syndrome, and mildly elevated LDL (128-138 mg/dL) on maximally tolerated statin therapy was diagnosed with adrenocortical carcinoma. She continued statin therapy through multiple different anti-tumor protocols including traditional agents, immunotherapy and mitotane. She returned to diabetes clinic twenty months after the diagnosis, after starting a new anti-tumor protocol following progression of disease despite three different protocols, where lipid profile was drawn showing severe hypercholesterolemia with elevations in total cholesterol (489 mg/dL) and LDL-c (388 mg/dL). Given her risk for CVD, intensive lipid lowering therapy was started by our multidisciplinary treatment team. LDL-c did not attain goal on a PCSK9-inhibitor, nor did it improve with testing a high dose of a different statin. Finally, after testing multiple different agents and combinations over the subsequent twelve months, the LDL-c has achieved goal of &lt; 100 mg/dL on a multi-drug regimen consisting of a PCSK9-inhibitor, statin, ezetimibe, and bempedoic acid. The LDL-c has now been maintained within goal range for six months. Discussion: This case illustrates the potential for severe refractory hypercholesterolemia induced by the treatment of adrenocortical carcinoma. Little literature exists guiding therapy for these patients. The present case suggests management may require multimodal therapy targeting several mechanisms of lipid metabolism, an escalation from traditional therapy. As survival outcomes for patients with many cancers improve with advances in treatment, management of risk factors for CVD is tantamount for reducing long-term morbidity and mortality. While routine lipid monitoring is not typically performed during cancer treatment, it may well be beneficial. Further research optimizing screening and treatment is warranted.
Abstract 14098: Early Recurrence Following Resolution of a Watchman Device Related Thrombus
Authors: Nikita Nand, Mohamed Diab, Deeptanshu Jain, garba rimamskep shamaki, David Corteville
Journal: Circulation (2022)

Introduction: Left atrial appendage occlusion devices are widely used as stroke prevention alternative to oral anticoagulation in patients with atrial fibrillation (AF). Recently, there has been growing concern for device related thrombus (DRT) and the associated risk for stroke and systemic embolism. Studies have mentioned the incidence, predictors, and risk factors for DRT post left atrial appendage occlusion devices. However, not much is known about DRT recurrence, and reports describing such events despite anticoagulation are very limited. Methods: This report describes early DRT recurrence post WATCHMAN implantation following initial treatment to resolution of DRT with anticoagulation. Results: A 79-year-old woman with permanent atrial fibrillation and no identifiable risk factors for DRT, underwent WATCHMAN implantation . TEE at 45 days showed a well-seated WATCHMAN device with no peri-device leak but revealed a DRT on the surface of the device, confirmed by CT angiography. Patient was prescribed Eliquis for 3 months and aspirin 325 mg daily was continued. Complete resolution of DRT was noted on a repeat CT scan 3 months later and Eliquis was discontinued. She returned approximately 1 months later (and few weeks after completing her 3-month course of Eliquis) for a repeat TEE, which now revealed a new recurrent DRT. Conclusions: This report adds to the current literature about early DRT recurrence and possible emphasis on continued anticoagulation following first DRT to prevent recurrence. Although several risk factors have been identified to predict DRT, it is unclear which patients are at increased risk for recurrence of DRT. Patient and procedural factors and the choice of oral anticoagulation seem to play a role. Figure 1: Appearance of device related thrombus on cardiac computed tomography (CT). Illustration of a hypo attenuated thickening on the surface of the left atrial appendage occlusion device suggestive of device related thrombus.
Abstract 13387: Perceived Quality of Care Differs Across Demographic Groups and is Associated With Incident Heart Failure and Total Mortality: The Atherosclerosis Risk in Communities (Aric) Study
Authors: artrish jefferson, Chiadi E Ndumele, Lena M Mathews, Priya Palta, Amil M Shah, Sui Zhang, Kunihiro Matsushita, Lisa Cooper, Beverly Windham, Justin Tcheugui, Joe Coresh
Journal: Circulation (2022)

Background: Disparities in the patient care experience are an important aspect of social determinants of health. However, the clinical impact of patient perceptions of their care experience is not well understood, especially among persons at risk for heart failure (HF) Methods: We studied 5,052 Visit 5 ARIC participants (mean age 76, 23% Black, 58% women) without clinical HF, who were classified as having stage A (HF risk factors) or stage B (subclinical cardiac dysfunction by echocardiogram or cardiac biomarkers) HF. We examined responses to the ARIC Access and Quality of Care (QOC) Questionnaire data, which included the following 4 questions: “Did providers (1) listen carefully; (2) explain procedures and tests clearly; (3) show respect and (4) spend enough time during visits? Using chi squared tests, we compared responses across sociodemographic groups (race, sex and the socioeconomic status [SES] variables of education, income, and area deprivation index [each categorized]). We used Cox regression models to assess associations of responses with a composite of incident HF and total mortality after adjusting for sociodemographics and CVD risk factors. Results: Individuals of Black race or with lower SES were more likely to answer “never” or “sometimes” (vs “always” or “usually”) to each of the 4 questions (all p&lt;0.001). Over a median follow-up of 6.4 years (1,249 events), answering “never” to providers listening carefully, showing respect, or spending enough time were each associated with greater risk of HF/mortality (Table). Answering “never” to 3 to 4 of the questions was associated with a HR of 2.74 (95% CI: 1.41-5.33) for HF/mortality compared to answering “always” on all of the questions. Conclusions: Among persons at risk for HF, those of Black race or with low SES were more likely to perceive lower quality of care, which was in turn linked to increased risk for HF or mortality. Enhancing patient-provider relationships may improve health equity in those at high HF risk.
Abstract 14219: Are There Sex Differences in the Imaging Modalities and Early Use of Echocardiography in Elderly Patients With Pulmonary Embolism?
Authors: Ghazaleh Mehdipoor, David Jimenez, Alfonso Muriel, Gregory Piazza, Rachel Rosovsky, Olga Madridano, Juan Bosco Lopez-Saez, Meritxell Mellado, Ana María Diaz Brasero, Michelle O'Donoghue, Laurent BERTOLETTI, Luciano Lopez-Jimenez, Manuel Nunez-Fernandez, Angeles Blanco-Molina, Martin R Prince, Marie Gerhard-Herman, Behnood Bikdeli, Harlan M Krumholz, Manuel Monreal
Journal: Circulation (2022)

Background: Sex differences in symptoms of acute pulmonary embolism (PE) in older adults (aged ≥65 years) may correlate with differences in the imaging modality used for confirming PE. It is also unknown if sex disparities exist in early use of echocardiography for prognostication. Methods: Using data from RIETE, a prospective multinational registry of patients with venous thromboembolism, we included older adults with acute PE. We compared the diagnostic modalities that were used in women vs men to confirm PE. We assessed the presenting symptoms/signs, thrombus location in patients diagnosed with computed tomography pulmonary angiography (CTPA), and evaluated PE severity according to the simplified Pulmonary Embolism Severity Index (sPESI) and the European Society of Cardiology (ESC) categories. We investigated the use of echocardiography within 3 days of PE diagnosis by sex. Results: REITE had 33,462 PE patients ≥65 years old including 19,294 women (mean age: 78.6±7.4 years) and 14,168 men (mean age: 76.1±7.2 years). CTPA was the dominant modality for PE diagnosis in both sexes, although a slightly smaller proportion of women were diagnosed with CTPA (77.1 vs 79.4, P&lt;0.001). There were no sex differences in the proportion of patients presenting with isolated subsegmental PE (5.0%; 99% CI, 4.6-5.5% vs 5.5% 99% CI, 5.0-6.0%). There were no clinically relevant sex differences according to sPESI or the ESC risk categories (Table). Women were not less likely, indeed slightly more likely, than men to undergo echocardiography within 3 days of PE diagnosis (51.1%; 99% CI, 50.3-51.9% vs 48.9%; 99% CI, 48.0-49.8%). Conclusions: Slightly greater use of CTPA for diagnosing PE in men compared to women may reflect more chest pain and hemoptysis on presentation in men. However, there is similar illness severity in elderly men and women and minimal disparity in early use of echocardiography after diagnosis for prognostication.
Abstract 13083: Lipoprotein(a) is a Residual Cardiovascular Risk Factor in Statin Treated Stroke Survivors - Insights From the SPARCL Trial
Authors: Kevin Chemello, Antonio Gallo, Gilles Lambert
Journal: Circulation (2022)

Introduction: Elevated lipoprotein (a) [Lp(a)] plasma levels are causally associated with CAD. The association between Lp(a) and stroke is however less clear. The SPARCL trial has demonstrated the superiority of 80mg atorvastatin to placebo for the prevention of stroke in patients with recent stroke or TIA. The aim of the current study was to investigate if Lp(a) is predictive of recurrent cerebrovascular and incident coronary events in these patients. Methods: Lp(a) concentration and apolipoprotein(a) [apo(a)] isoform size, a strong determinant of Lp(a) plasma levels, were measured by LC-HRMS in samples collected at baseline from 2814 SPARCL participants (1418 randomized to atorvastatin &amp; 1396 to placebo). Within each treatment arm, we compared patients in the highest quartile ( &gt;84.0nmol/L ) with those in the lowest quartiles of Lp(a) concentrations and patients in the lowest quartile ( &lt;25.9 KIV domains ) with those in the highest quartiles of apo(a) size distributions. The relationship between these parameters and subsequent events was established with a Cox proportional hazard model adjusted for age, sex, type of entry event, time since entry event, BMI, smoking, hypertension, non HDLC and DM. Results: In patients randomized to atorvastatin, elevated Lp(a) concentrations and shorter apo(a) isoforms were independently associated with an increased risk of coronary events [HR (95% CI) of 1.607 (1.007-2.563) p=0.047 &amp; 2.052 (1.303-3.232) p=0.002 , respectively]. These associations were primarily driven by a significantly higher incidence of coronary revascularisation procedures, stable angina requiring hospitalization, and MI. No such association was found in patients randomized to placebo [0.925 (0.606-1.412) &amp; 1.105 (0.735-1.659)]. We did not observe any significant association between elevated Lp(a) concentrations or short apo(a) isoforms and the risk of recurrent cerebrovascular events in patients randomized to atorvastatin [0.794 (0.586-1.076) &amp; 1.114 (0.760-1.352)] or placebo [0.914 (0.688-1.214) &amp; 0.940 (0.709-1.248)]. Conclusion: Lp(a) contributes to the residual CAD risk of statin-treated stroke/TIA survivors, paving the way for the use of novel therapies targeting Lp(a) in patients with a history of stroke and elevated Lp(a).
Abstract 12768: Evaluation of a Cardiovascular Research Initiative on the Research Career Development of Medical Students
Authors: Anusha Gandhi, Jannel A Lawrence, Marcella Meykler, Akiva Rosenzveig, Fariha R Hameed, Lucia Schroeder, Sebahat Ulusan, Toufik Abdul-Rahman, Wireko Andrew Awuah, Samip Sheth, Tasha Phillips-Wilson, Mariana L Henry, Emily Gates, Adriana C Mares
Journal: Circulation (2022)

Background The Cardiovascular Research Initiative (CVRI) was founded in 2021 by leaders and members of the American College of Cardiology (ACC) Medical Student Member Community (MSMC) to bring together students passionate about conducting cardiovascular research. The group comprises 62 students who worked on 7 review articles since December 2021 under the guidance of physician mentors. The CVRI also aims to develop members’ research knowledge and skills and thus held a webinar on ‘Key Steps in Conducting Systematic Reviews’ in February 2022. Methods Two surveys were created and distributed to members of the ACC MSMC. The surveys were used to assess the overall impact of the Research Initiative and Systematic Review Webinar on the career development of medical students and evaluate the diversity of participants and inclusiveness of the projects. Results From the Research Initiative author survey (n = 12), 92% of respondents identified as being from underrepresented backgrounds, had prior research experience and believe that research is a valuable part of their professional development. All respondents agreed that after participating in these research projects, they are likely to pursue research later in their careers, and 92% strongly believe that participating in the Research Initiative is a valuable experience for their research career development. The Systematic Review Webinar feedback survey (n = 12) was completed by 30% of attendees, most of whom were in their last 2 years of medical school from 8 different countries. A total of 84% of respondents felt that the webinar improved their knowledge of performing a systematic review and 50% felt prepared to conduct a systematic review after attending. Additionally, 84% felt that the virtual nature of the webinar enhanced their research knowledge and would attend and recommend future webinars on research methods and related topics. Conclusions The CVRI provides students from various countries and underrepresented backgrounds with opportunities and knowledge to succeed in research through manuscript writing experience and educational webinars. With its growing number of participants, the ACC MSMC continues to cultivate cardiovascular research career development among medical students.